Narrative Therapy vs. Cognitive-Behavioral Therapy for moderate depression: Empirical evidence from a controlled clinical trial

Abstract

Background: Systematic studies of the efficacy of Narrative Therapy (NT) for depression are sparse. Objective: To evaluate the efficacy of individual NT for moderate depression in adults compared to Cognitive-Behavioral Therapy (CBT). Method: Sixty-three depressed clients were assigned to either NT or CBT. The Beck Depression Inventory-II (BDI-II) and Outcome Questionnaire-45.2 (OQ-45.2) were used as outcome measures. Results: We found a significant symptomatic reduction in both treatments. Group differences favoring CBT were found on the BDI-II, but not on the OQ-45.2. Conclusions: Pre- to post-treatment effect sizes for completers in both groups were superior to benchmarked waiting-list control groups.

Background: Sono pochi gli studi sistematici sull'efficacia della terapia Narrativa (NT) per la depressione. Obiettivo: Valutare l'efficacia della NT individuale per la depressione moderata in adulti rispetto alla terapia cognitivo-comportamentale (CBT). Metodo: 63 clienti depressi furono assegnati sia a una NT che a una CBT. Il Beck Depression Inventory-II (BDI-II) e l’ Outcome Questionnaire-45.2 (OQ-45.2) sono stati utilizzati come misure per l'outcome. Risultati: Abbiamo riscontrato una significativa riduzione dei sintomi in entrambi i trattamenti. Nel BDI-II sono state rilevate differenze nei gruppi a favore della CBT, ma non nella OQ-45.2. Conclusioni: Gli effect-size pre e post trattamento per chi aveva completato il trattamento in entrambi i gruppi erano superiori al gruppo di controllo in lista d'attesa.

Racional: Existem poucos estudos sistemáticos de eficácia da Terapia Narrativa (TN) para a depressão. Objetivo: Avaliar a eficácia da TN individual para a depressão moderada em adultos quando comparando com a Terapia Cognitiva-Comportamental (TCC). Método: Sessenta e três clientes deprimidos foram alocados para TN ou TCC. O Inventário de Depressão de Beck-II (BDI-II) e o Outcome Questionnaire-45.2 (OQ-45.2) foram utilizados como medidas de resultado. Resultados: Encontrámos uma redução sintomática significativa em ambos os tratamentos. No BDI-II foram encontradas diferenças entre os grupos que favorecem a TCC, mas não no OQ-45.2. Conclusões: Os tamanhos do efeito do pré e o pós-tratamento para os indivíduos que concluíram o tratamento foram superiores, em ambos os grupos, aos resultados encontrados nos grupos de controlo em lista de espera.

Hintergrund: Systematische Studien über die Wirksamkeit Narrativer Therapie (NT) gibt es wenig. Ziel: Die Evaluation der Wirksamkeit von individueller NT für moderate Depression bei Erwachsenen verglichen mit kognitiver Verhaltenstherapie (KVT). Methode: 63 depressive Klienten wurden entweder NT oder KVT zugeordnet. Das Beck Depression Inventory-II (BDI-II) und der Outcome Questionnaire-45.2 (OQ-45.2) wurden als Ergebnismaße verwendet. Ergebnisse: Wir fanden eine signifikante Symptomreduktion nach beiden Behandlungen. Gruppenunterschiede zu Gunsten der KVT zeigten sich beim BDI-II, aber nicht beim OQ-45.2. Schlussfolgerung: Die Prä-Post-Effektstärken für diejenigen, die die Therapie beendeten, waren in beiden Gruppen größer als die Bezugsnorm der Wartelisten-Kontrollgruppe.

背景：目前只有少數的研究探究敘事治療應用於憂鬱症的成效。目標：比較敘事治療與認知行為治療在介入中度憂鬱症成人患者的成效。方法：63位憂鬱症患者被分派到敘事治療與認知行為治療二組，同時使用貝克憂鬱量表（BDI-II）以及成效問卷（OQ-45.2）進行測量。結果：二組之症狀均有顯著降低。認知行為治療組的患者在貝克憂鬱量表的測量上有明顯的改善，但是在成效問卷則沒有顯著的差異。結論：完全參與兩組之患者，其所呈現的前後測效果值顯著高於等待控制組的患者。

Keywords:

• depression
• treatment of depression
• psychological treatment of depression
• Empirically Supported Therapy (EST)
• Narrative Therapy
• Cognitive-Behavioral Therapy

Acknowledgments

An earlier version of this article was presented at the 41st international meeting of the Society for Psychotherapy Research, SPR, held in Asilomar, CA, USA, in June 2012.The authors thank Michael J. Lambert, William B. Stiles, and Joshua Lipsitz for their suggestions on this research, the clients, therapists and staff at the Psychological Service at University of Minho who have participated at the study, and Cátia von Doellinger, for the help with the organization of the data.

Funding

This article was supported by the Portuguese Foundation for Science and Technology (FCT), through the Grant PTDC/PSI-PCL/121525/2010 (Ambivalence and Unsuccessful Psychotherapy, 2011–2014, coordinated by M. Gonçalves) and through doctoral grants to R. Lopes (SFRH/BD/47343/2008) and to T. Bento (SFRH/BD/48266/2008).

Additional information

Funding

Funding: This article was supported by the Portuguese Foundation for Science and Technology (FCT), through the Grant PTDC/PSI-PCL/121525/2010 (Ambivalence and Unsuccessful Psychotherapy, 2011–2014, coordinated by M. Gonçalves) and through doctoral grants to R. Lopes (SFRH/BD/47343/2008) and to T. Bento (SFRH/BD/48266/2008).